One of the more challenging decisions to make for you and your family is when to move to a nursing home. It may have been hard to find care for aging adults that met your needs, and you may be happy at your assisted living facility with no desire to make a move.
But other circumstances can force a move from assisted living to a nursing home, such as declining health or the need for 24-hour caregiving. In these cases, assisted living can be limited and require you to move to a nursing home.
If you or your loved one are unsure as to the need for such a move, here are some reasons you may want to consider.
Are You Ready to Move From Assisted Living to a Nursing Home?
In some cases, the assisted living community will make a decision and ask you to move. In that situation, you can plead your case—and we have tips that can help.
Otherwise, the level of care you need can’t be provided by assisted living. Although assisted living staff can do a lot, they can’t do everything to keep you safe.
Once you have exhausted all of your options, it might be time to move. If you've decided you're ready to move, but not ready for a nursing home, read our guide on alternatives to assisted living.
Signs you might be ready to move
It is a fine line deciding when it is no longer safe to stay in assisted living. Even with other supportive care coming into assisted living, it can be hard to manage that care. There are signs when it might be time to move.
In and out of the hospital
If you are in and out of the hospital, it might be better to be in a nursing home. Going in and out of the hospital is stressful and, although necessary at the time, doesn’t always lead to better outcomes.
Some of the reasons a person is hospitalized frequently are recurrent infections, worsening of chronic medical conditions, frequent surgeries, or inability to rehabilitate. In cases like these, nursing home care can help stabilize someone without the strain of repeated hospital stays.
Many nursing homes are like hospitals with the equipment and personnel necessary to treat someone safely and effectively.
End-stage Alzheimer’s or severe neurological problems are challenging to manage in assisted living or at home. Even in memory care, some behaviors and functional conditions are better handled in a nursing home.
It is estimated that 50 to 70 percent of nursing home residents have some form of dementia. As Alzheimer’s progresses, the ability to function physically and mentally deteriorates. These are some of the common symptoms you may see in people with dementia:
- Aggressive behavior towards other residents
- Self-harm behavior
- Significant confusion and disorientation
- Refusing care and wandering
- Maximum assistance with bathing, grooming, dressing, and eating
Nursing homes are able to handle these issues. They have the ability and skill to monitor, manage, and help people with dementia.
Complex medical needs
Assisted living communities are not equipped to deal with complex medical issues. Even with time-limited home health, some medical problems require additional care and oversight.
For example, you may want to move to a nursing home if you require some of the following medical needs:
- IV fluids or antibiotics
- Chronic Obstructive Pulmonary Disease (COPD)
- Other heart and lung conditions
- Mobility issues like difficulty walking or transferring
- Wound care
- Respiratory care
Many assisted living communities will not accept someone who requires two staff to assist with walking and transferring. Once you need this level of help, some assisted living communities will recommend nursing care. Stand and lift devices are also not allowed.
The main reason for this rule is that several states mandate that a resident needs to be able to evacuate assisted living with minimal help during an emergency.
For other communities, the staff is not available to do two-person assists. You can imagine what it would be like if many of the residents required this level of assistance. It would be unsustainable and unsafe.
“Round-the-clock” nursing care
When we say “round-the-clock” nursing care, we mean 24-hour nursing availability. Assisted living communities have nurses on staff, but they are not able or equipped to attend to someone 24 hours a day.
Nurses in assisted living do more coordination of care and general assessment of medical conditions and medication management. They also do the initial evaluation for admission to assisted living. Nurses in nursing homes have many responsibilities, starting with overseeing the medical care and condition of residents.
They are also required to coordinate this care with other physicians, certified nursing assistants (CNAs), and plan said care in consultation with family members.
They must also attend to specific medical needs such as the following:
- Starting IVs
- Administering oxygen
- Skin assessments
- Pain management
- Obtaining lab specimens
- Blood sugar checks
- Monitoring vital signs
Swallowing issues or dietary restrictions
Swallowing problems are common in people with Alzheimer’s and other neurological conditions.
Once a speech evaluation is completed, a modified diet is often recommended. These diets are specific, and for those with swallowing issues often require one-on-one supervision.
This type of monitoring is rarely possible in assisted living. Nursing homes have designated dining areas for residents who have swallowing problems.
Becoming bed bound
Confinement to a bed is the result of several different conditions and requires intensive staff involvement. Conditions that result in becoming bed bound are mobility problems, infections, general debility, pneumonia, broken bones, among others.
The longer someone is bedridden, the weaker they become. Taking care of someone who is bed bound involves some of the tasks:
- Assisting with eating
- Frequent turning to prevent bedsores
- Bathing, dressing, and grooming
- Stretching to prevent contractures
Limited financial resources to support assisted care
Unfortunately, some people don’t have the financial resources to pay for home care or assisted living. Just because someone doesn’t have money doesn’t mean they can go to a nursing home. Nursing homes require that specific criteria are met—namely, that there is a nursing need.
If finances are limited to the point where you qualify for Medicaid, then nursing home care may be the best choice. They will have the care you need to keep safe. Some states have Medicaid Waiver programs that will work with families to move someone from nursing care to assisted living.
The idea is that with enough medical support in assisted living, some may do well in that environment at a lower cost than that of a nursing home.
You are on hospice care
Assisted living residents can be in hospice care. What many people don’t realize is that being placed in hospice is nowhere near 24-hours a day.
A nurse might come in two to three times a week with aide service. Under particular circumstances, a patient might qualify for “continuous care” for a short time to get severe symptoms under control. A person can be in hospice and also require more care than what hospice can provide.
In these cases, some families opt for nursing home placement with hospice. With both supports, you will have both the nursing home and hospice team managing your care.
Signs you might not be ready to move
If you are on the cusp of needing to move to a nursing home and want to avoid it, you can try a few steps first. A proactive and creative approach may delay or even eliminate the need to move.
You can augment with personal and nursing care
With enough financial resources and the permission of the assisted living, it is possible to put enough support in place to stay in assisted living. This support would be a combination of paid caregivers and private nursing.
If an assisted living community has suggested you move to a nursing home, get specifics on why. It is possible to solve problems if you know what they are.
For example, if you need someone to accompany you to the bathroom during the day, hiring a caregiver can help. Or if you need mealtime supervision, a hired caregiver can also take on this task.
Some issues can’t be resolved, but before everyone takes the critical step of moving you to a nursing home, try to work things out. More than likely, the assisted living community may not have the time, resources, or staff to attend to your specific problems. They will probably be happy for you and your family to tackle some of these problems.
Your medical conditions are likely to improve
If you have an acute or chronic medical condition that might improve, this is the time to throw everything at the problem to stay in assisted living.
If you have completed skilled nursing rehab and there hasn’t been enough improvement, here are some suggestions:
- Use home health for nursing and physical therapy.
- Once home health is completed, consider hiring a physical therapist to continue working with you. Many people use this option to continue therapy once insurance no longer pays.
- Hire a private caregiver to encourage exercise and movement outside of therapy visits. Private caregivers also offer valuable reinforcement of healthy habits like eating, hydrating, and getting out of bed.
- Talk to your doctor about any suggestions to hasten improvement. Ask to have your medications and medical condition reviewed.
If you haven’t exhausted your home health benefit, see if you can qualify. It is possible to qualify more than once in a year. Home health is time-limited, and the support you get might be enough to keep you in assisted living.
Take the view that home health is a teaching moment, and tackle the recommendations with vigor and focus. Home health can offer some of the following services:
- Nursing. A nurse will come to see you at least once a week to monitor your condition.
- Physical therapy. A physical therapist will help with mobility and balance.
- Occupational therapist. An occupational therapist will teach you how to adapt so you can resume normal activities like cooking, eating, dressing, and grooming. They also assist with improving cognitive skills.
When to Move from Assisted Living to a Nursing Home
Most people do not want to make a transition from assisted living to a nursing home. In some cases, it may be inevitable, but taking some proactive steps can give you a chance at making an informed decision.
Above all, do what you can to take control of your health to get better control over your choices.
- “Nursing Homes.” HealthinAging.org. www.healthinaging.org/age-friendly-healthcare-you/care-settings/nursing-homes